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xr�a <br />�'a� <br />A xl 5 <br />C H <br />9 H C/� <br />H 93 <br />�_. z H <br />� y� <br />O"�] H �O-7 <br />y�C <br />� O C�:7 <br />H C7 <br />O H <br />��g <br />c� � c� <br />zH� <br />ryz <br />HH <br />o�'H <br />o �m <br />� r <br />z y c�n <br />H O Cl� <br />P �� <br />Ihrf�rrrFrrrn � Y�V ■ ■ ■�/�/���• _ <br />CITY OF r�C <br />i�'��er�[,lr �ERMiT PERMITNO. L,J��' <br />259-8810 <br />;: DEMOLITION u COMBINATION X%BUILDING ❑ MECHANICAL ❑ PLUMBING u SIGII <br />IAAILA��i�ESS CIiV 21� PNONE <br />����ouglas Hallstrom 28128 Florence Acres Rd. taonroe 9R272 793-0947 <br />—, .,.;r v.n��nooness urv ziv v��or:c <br />��� �.'CGTOfiDES�GNER I:.MLFODRE55 Ciiv Zin PNONE <br />:��:A�..GONTRRCTOR MAILAOfIPE$5 Cltv ZIP PMONE LICF:`� <br />Cox Construction 5125 - 75th Ave NE P]arysville 98270 659-1277 COXCO**169N8 <br />....;..p.C4LCONTRPCT01i NAILAOORESi GTY 21P PIICNE LILEIJiC. <br />�. •^.iFGCONTRACTCF !�PILPOORE55 CITY Z�o GIIONE UCLN`. <br />. ,.. -�ti UF WOPK <br />.'= NEW ❑ ADDITION ❑ ALTERATION �EPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />I CONT�CT PEPSON AND PnONE NO IF O�MtN i HnN ne��c <br />nnNTRACTPRICEOFWORK:$ 23�000.00 (CHIP SOB) <br />.. LfRipE Y:ORN ANO SO�AFE �OOTAGE iNVOLVE� <br />Install block foundation & re-roo£ <br />. �-�r�oseo ust ov euaowc <br />Duplex <br />. i:'v,L OESCRIPiION UF CFOPEPTY ISNOIV OELOW OR ATT/CH FOUR CO��E51 10/16/90 12:59PM OQ��k4170 �k:k:k <br />� — <br />, — o�ocK— or H00015819 <br />F�_Ilf. �234.00 <br />• e s�cH sa.so <br />JOOACDFE55 <br />2212 H <br />Pt.UMBING <br />NO. � <br />LAVATORVIWAS <br />SH�WEF <br />KITLHEN $INK 3 <br />�ISHWASNER <br />LAl1NORY TPAV <br />FI%TURE OR <br />URINAL <br />n <br />B OFINKING FOUNTAIN <br />* FLOOR ORAIN <br />BACNFLOW PREVENTERS <br />"� POOF DRAINS — RAINLEP <br />� �s SINK �SE(iVICE — BAR, ET <br />I � � <br />-RONiSETHPCN <br />C.'ONE <br />,. �; ov con5raucuon a �owai <br />'.:(O�OIOG <br />.curpNCVLOnO <br />. . m:ow roa sra�!�rc�ens <br />..-1 -.�.��.:riinrc ur <br />SUBTOTAL <br />PEPMIT <br />TOTRLFEE <br />pEAti5L1bACM <br />LOT AR[A <br />NO O�SiORIB: <br />• <br />rinE scnir+Kicns n�o�o <br />❑ YES ❑ NO <br />HE <br />nr <br />S <br />S <br />MECHANICAL <br />NO. 7YPE OF EOUIPMENT <br />A;�G — AiHN�LG 11N1T5 — H P. <br />FORCE�AIRSVSTEIAS—BT.U. M <br />UNIT HEATERS — B T.0 M <br />CLO?H@SDRYERS <br />VENTILATIJN FAN <br />RANGEHOOD <br />W4TER HEA"4 <br />WOOD`"OVE <br />M i i Al FlFEPLACE /. CHIMNEY <br />FIREPLnC`_�NSEFi <br />MEATPUMP <br />GA$ PIPING <br />E%HAUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />SioES[tnnCK PLANCHECKNUME3EFl �EE <br />vncnm* site FEES <br />❑ YES ❑ NO <br />�x1�a��-• imo�oxuuxcunirs BUiLDiNG <br />FLUMBING <br />HASEMENT <br />❑ YES ❑ NO MECHANICAL <br />HeicMrunnTanor� OTHER <br />STATE DUILDWG SUFCHARGE <br />STATEENEFGYSURCHARGE <br />CITY OF EVEFlETT pUBIIC WORKS <br />LOCALSALES <br />TAX CODE IS TOTAL <br />PEPL1ITS E7:PIR[ IF WOFiK IS NOi" COMMFNCED WITHW ;,��,;;;,...-,-, I:.�. <br />1B0 G^YS OR rEa5F5 ��OR MORE THAN 180 DAYS. <br />� <br />f <br />f <br />�ECEIP7 NO <br />FEE <br />YOUR <br />i__ �'' . � <br />